Beyond Being a Therapist is Hard Work: Curt and Katie respond to listener feedback
Curt and Katie received feedback on a recent episode, Don’t Let Tik Tok Fool You: Being a therapist is hard work, an interview with Anita Avedian and Sandra Kushnir. We talk through the feedback that the perspective was too one-sided (primarily from the employer angle) and that it was too much in support of the status quo. We share our perspectives as well as how big of a challenge we’re facing as a profession to become sustainable.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we talk about the challenges of making the therapy profession more sustainable
We received a lot of feedback about our episode with Anita Avedian and Sandra Kushnir. We decided it was worth addressing the feedback directly and continue the conversation.
Why is there a tension between experienced and new mental health professionals?
“There is a necessary tension between the experienced folks who are trying to make it work within the system that is present… and the new folks coming in and going, this is not okay. This system is broken. You need to fix it.” – Katie Vernoy, LMFT
- The “necessary” tension between those who support what is and those who advocate for what should be
- Supervisors or managers who reinforce what has been seen to be unsustainable in the field
- New clinicians coming in and advocating for things to be better and more sustainable
- The challenge with innovating when the system has burned someone out
What are the challenges in the therapy profession in 2024?
“I can’t innovate if I’m making less than what the cost of living in an area is.” – Curt Widhalm, LMFT
- Burnout
- Lower pay (that is not keeping up with inflation)
- A workload that seems unsustainable, especially to newer clinicians
What can therapists do to improve their profession?
- Read Saving Psychotherapy by Dr. Ben Caldwell
- Look for opportunities to reimagine the field, by looking at other sectors (or disruptors in the field like technology)
- Support advocacy efforts through unions, professional associations, or lobbying legislators
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Saving Psychotherapy by Ben Caldwell
Relevant Episodes of MTSG Podcast:
A Living Wage for Prelicensees
What to do when supervision goes bad? A guide to supervision ruptures and repair
Getting a J-O-B as a Therapist
I Just Graduated, Now What? – Career Advice for New Mental Health Clinicians
Interview Strategies for Therapists
Does Your Social Media Make You Look Like a Bad Therapist?
Why Therapists Shouldn’t Be Taught Business in Grad School
Topic: Pre-Licensed
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:12
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about the things that go on in our profession, the things that we face as professionals, and also the things that come up on this podcast. And this is a follow up episode to the episode that we had a couple of weeks ago, where we were joined by Anita Avedian and Sandra Kushner in talking about the realities of joining into the therapeutic fields, and we got some listener feedback and just some of our own reflections about some of the things that were discussed in that episode, and wanting to just kind of keep the conversation going. And some of this was feedback in our Modern Therapists Facebook group that we had received, some people had reached out to us directly. And I would describe the feedback that we did get is ‘get off my lawn’ is kind of how this came across. A little bit of out of touch for people who are actually entering into the workforce, some of the advocacy things that are going on, and hear our conversation over the next little bit, continue to give us feedback in our social media and in our Facebook group. But Katie, what are your reflections over the past couple of weeks since that episode is aired?
Katie Vernoy 1:41
I found myself feeling a little bit caught in an us versus them. The privilege that I have sitting as a private practitioner, without employees, without a supervisor, I get to do what I want, and so I don’t feel that sway necessarily. But I know in the work that I’ve done with group practice owners, as well as with folks looking for jobs and all of that kind of stuff, I feel like there’s this element of they’re not trying hard enough. They are making it worse. They’re making it impossible to do the job, whatever it is. And even as I’m saying that, I realize that can come from either side, that the group practice owners are in it for themselves, and they’re just want to get rich, and they’re doing stuff that was done to them, and that’s not fair. And then there’s also the supervisors going like these entitled youngins in the field and all of that, they’re making it hard. We can’t afford what they want, or, you know, that’s unreasonable to expect, and all of those things. And so we’ve talked about this a number of different times. I’ll put some different episodes in the show notes over at mtsgpodcast.com. But I think what it really comes down to for me, and I’ve said this probably 20 times over the years, is that there is a necessary tension between the experienced folks who are trying to make it work within the system that is present, and then there’s the and the tension is between them and the new folks coming in and going, this is not okay. This system is broken. You need to fix it. I’m not going to stand for this. And I think that’s how potentially innovation and advocacy can happen. But I think too often, we’ve found that folks will move into that place. They’ll kind of get beat down over the years by the system as it is. And then potentially, if they haven’t been able to take care of themselves, or if they haven’t been able to shift how they operate, they end up getting into this space of having the same structure that they grew up in, so to speak, and forcing it onto their their employees.
Curt Widhalm 4:03
I think my initial reaction to that discussion was, I see where both sides are coming from. Maybe this is my dbtness, just kind of embracing both sides, seeing that there’s truth from both sides, and I get the need for being able to have frank discussions about this is where the the workforce is. This is where the jobs are. This is what the opportunities are, as you’re just describing, that for many people who have gotten into managerial positions or started and innovated on their own, came from a place of mission and came from a place of being willing to work extra hours, and I know group practice owners like myself, like Anita, who we work way more than a lot of people out there do, or possibly even can, because of various personality and various lifestyle factors. And we get that not everybody can or should do the kinds of things that we end up doing. I think that there’s also a very practical reality that those of us who have not been in school, not been in the climate of what education costs now. I know in comparison to what a lot of grad students are facing just to get through grad school right now, makes what even you and I paid for our graduate education seem like a can of soda or so. I get that there is two different realities that are faced at different points in the career, and you and I have been longtime advocates for especially pre licensed people entering into the field to be respected as the workforce that they are. And that’s some of the work that we did, as far as getting the California Association of Marriage and Family Therapists to make a statement that best practices of supervision are to pay a living wage.
Katie Vernoy 4:03
Yeah.
Curt Widhalm 4:04
And it took us a long time to get that. And I think that that has been something that has been influential in the what is it, six or seven years since we got that to be a statement that was made, that I think has influenced some of the practices here in California, and I think that it’s also something where, as you’re describing the investment by governments, the investment by insurance companies into even paying licensed people a living wage is still very much a problematic thing, and that’s some of the thing where having a discussion about, hey, graduate students, here’s The field that you’re entering into right now gets met with this kind of response.
Katie Vernoy 7:04
One of the things that stood out to me when when you were talking is that we are in California, and so there’s a lot of employee protections, and there’s other things that make even what Anita and Sandra were talking about almost impossible in other places, because folks can have different employment strategies or different ways that they go about things. There’s different minimum wages, there’s different requirements, and so I think we come from a place of employee advocacy, and so there may be paired with that employer exhaustion and frustration, because the system in California, anyway, is set up that employees oftentimes get the better deal if there’s ever any big problems. And so I think that can add to the us versus them mindset. And I also think that it’s a great place to be able to innovate, and I’m surprised at the the lack of folks doing some of that. And maybe it’s creativity that’s lacking, maybe it’s burnout, maybe it’s just I need to survive until I can get through to retirement. But one of the responses in our Facebook group, they were saying that they are expecting going forward, that the people who are 20 years ahead of them will be innovating to protect the folks coming up behind. And certainly that was my intention. I ended up not doing that, not out of spite or anything, but out of exhaustion, I worked for myself. I did not stay in supervision and management and that kind of stuff. I try to help other people, so maybe I’m vicariously innovating and helping people to be better employers. But I think the system can also burn us out, and I think that expectation that experienced clinicians will be protecting them is a beautiful thing and maybe unrealistic, and that makes me sad.
… 9:07
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Curt Widhalm 9:07
I want to look at a couple of pieces of feedback that we got here and maybe use this as a more specific launching point. From our Facebook group, the Modern Therapist Group, one commenter said I felt let down by the guests on this episode, if I understood correctly, they were suggesting that increased awareness of burnout in grad school has led new grads to wanting to see 15 clinical clients a week. And rather than using this as an opportunity to be curious about whether 15 clients a week would help therapists sustain their career, they’ve designed a course to remind therapists that the expectation is 25 to 30 hours per week. We’ve been telling employers for years now that the new norm are clients with increased complexity, increased ethical and legal considerations and increased expectations for our services. Seeing six plus of these clients every day is increasing our emotional labor and risk of burnout and because we don’t want to compromise on delivering safe and effective services. We want to see fewer clients or not take on complex clients outside of our scope. And if a staff member is telling you this even after you say but we’ll support you, means that the employee doesn’t believe that you will provide the level of support needed, feels like these guests are not listening and instead just hammering the same status quo that’s left us broken in the first place.
Katie Vernoy 10:23
Yeah, I think that that is relevant and speaks to that tension, right? Because, and we talked about this in our supervision, you know, like rupture episode, but there were times when the system didn’t allow me to provide fewer clients to my supervisees due to the wait list and the different things and all that kind of stuff. And I could advocate, but I wasn’t able to drop caseloads dramatically, even though I knew it was unrealistic. And so I kind of engaged with the person in the Facebook group and talked about that tension, and their response was to innovate, right? To look for other places, to get financial resources, to find ways to decrease caseload, and all the stuff that people in private practice end up doing, which is diversifying their income. And so I feel like this is the refrain we’ve heard for years, right, that I can’t change anything. The system doesn’t let me do it. Well, you should innovate, but what does that mean?
Curt Widhalm 11:30
And also, I can’t innovate if I’m making less than what the cost of living in an area is. And this has been one of the conversations that you and I have been hearing for years is where employers or agencies that don’t have the funds to be able to pay for more staff, pay for more training, be able to pay for more of the clinical care hours that goes outside of the one to one therapy that say, if these are the employment obligations that we have it’s actually just better for us to close our doors or not have employees and work just one on one as a therapist. And I have seen a trend of even group practice owners closing down their practices, their group practices, to just focus on doing solo clinical work.
Katie Vernoy 12:20
Well, and I think the alternative is raising prices on private pay clients, which either is unsustainable if you can’t get folks to pay it, or it increases the problems with access, right? I mean, we can bang the drum a million times a day about wages being low in our field, about not having sufficient insurance coverage, not having the ability to get affordable health care to our clients. But those are things that oftentimes are not paid attention to by insurance companies or governments or those types of things. Like they like you were saying before, they’re in the business of keeping costs down, not in making sure that people get the services that they need. And I would argue, insurance is actually in the business of making a profit, not on making sure that costs stay down or patients get what they need. So it’s it’s a big challenge. You have to weigh do I have access for the community? Do I have positive pay for my clinicians? Do I make a living? Do I get a better work life balance? Like there’s so much, so many decisions that have to be made as a group practice owner that really are very challenging, unless you’re in a very wealthy area and can just do out of pocket.
Curt Widhalm 13:49
It’s been a while since we’ve referenced what I think ties together a lot of what our intentions are, and that is ‘Saving Psychotherapy’ by Ben Caldwell, a great friend of the show. And there’s a lot of things that Ben does really, really well in that book. And I can’t wait for ‘Saving Psychotherapy 2: psychotherapy harder’ to come out. One of…
Katie Vernoy 14:19
You’ve got a new assignment Ben.
Curt Widhalm 14:20
One of the things that he writes about in that book is the mean annual salary for the psychotherapy professions adjusted for inflation, and this is what he had written, was up to 2014 so looking from 2007 to 2014 he separates it out by psychologists, MFTs, counselors, LCSWs. I’m just going to focus on MFTs, because I don’t want to just spout numbers at everybody for the next five minutes.
Katie Vernoy 14:50
That’s a good idea.
Curt Widhalm 14:51
But in 2014 dollars tracking what MFTs were making, they were making about $51,000 per year in 2007 that’s in 2014 dollars. And by 2014 MFTs were making about $51,000 per year.
Katie Vernoy 15:12
Got it.
Curt Widhalm 15:14
I looked at the Bureau of Labor Statistics, and this is the same source that Ben used in his book as of May 2023, the medium annual wage for American marriage and family therapists in 2023 was $58,510. Seemingly going up. But if we adjust for inflation, those 2014 dollars in 2023 MFT should be making $77,000
Katie Vernoy 15:51
But that’s a huge backslide.
Curt Widhalm 15:53
Huge backslide. And I think that this is one of the things where the longer that we’re in the field, we can kind of anchor on to different dollar amounts that were present when we were early in our career, and that ends up becoming something that, amongst the grants and the government programs and everything else, also stifles what we believe that things actually cost. You know, this is the Arrested Development, kind of Lucille Bluth, kind of, how much can a banana cost? $10? Like that ends up making some of the people who’ve been around, like when grad school, you know, back in the 80s, cost, you know, $6. It was something that doesn’t face the reality of the ever, ever expanding requirements that go to just getting through grad school. And I’m seeing more and more people who reach the end of grad school and are saying, I need time off just before I’m even ready to enter into the workforce. And while you know, I’m seeing entry level jobs in some of the community mental health in Los Angeles be in the mid $60,000 now I remember back when I was leaving grad school, and those numbers were in the $40,000s. And that still doesn’t meet the bare minimum for what Los Angeles County says is the poverty level for people who are living here. So some of this is, you know, go read ‘Saving Psychotherapy’ that should be mandatory reading before you apply for grad school at this point. And really looking at the field hasn’t changed that much. The innovation that’s needed, the advocacy to actually change is not just a fight against the group practice owners or the managers, but it’s also to the government regulators. It’s the politicians. It’s the people in charge of the insurance commissions that holds the insurance companies accountable to actually having to pay. And that’s a lot of time that nobody has. It’s time that you’re potentially not getting paid for because you’re out there trying to survive. And that’s other stuff that’s just kind of continuing the cycle that we’re in is, hey, we’re all busy, and there’s part of this that is, by the time that you survive in this field, long enough to actually make money, you’re so entrenched in being able to actually now get ahead just a little bit personally, that we’re forgetting that we’re just kind of rolling the carpet behind us and not welcoming the new people into the profession anymore, or we’re still not doing it.
Katie Vernoy 18:46
I think still not is more accurate.
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Katie Vernoy 18:51
I was looking through an email that I got from a listener who also is a friend of mine, and and she was talking about the mixed feelings. She’s a more experienced clinician. And looking at the realities of it versus what she can do now, 20 years in. And there is so much both and that comes into this, but in hearing about the decrease in wage and all of those things like it just feels so disheartening. It feels demoralizing to think that we’re not able to make it better. And I don’t know if other fields feel the need to do this, I know that sometimes unions work on these types of things or other types of advocacy groups, whether it’s professional associations, those types of things, but as a field, it feels as though we’re stuck in this struggle to survive. I think before we hit record, you said we’re just staying at that place of not quite drowning. Or continuing to drown like it’s not totally easy to sort through.
Curt Widhalm 20:04
What I had said is all of the efforts that you and I have put into advocacy, the efforts that we put into getting statements made by CAMFT that none of the other professional organizations have made some of the same statement. So, the countless conversations and arguments that we’ve had with agencies to address the ongoing workforce problems that we have, the number of times that we talk about this on this very podcast, and we engage with listeners and encourage them to have conversations in this way with their professional associations, and that what we’re trying to do is keep that carpet out there and keep it at least dusted off or vacuumed every so often. But it’s not doing enough as far as the efforts that you and I are putting out there on our own to be able to address this stuff. And so it feels like the just okay, we recognize everybody’s drowning, and what we can do is just drag people along at the top of the surface of drowning, and we’re trying to keep everybody there, but it’s still very much something where once all of you wonderful, pre licensed listeners get to the place where you are stable, don’t lose this fire, because it does take years and years of this, and Katie and I have been doing this for years and years, and it’s still status quo. We’ve we’ve been fighting what we hopefully consider to be the good fight. Katie and I are both privileged as hell when it comes to where our situations are. We have the time to do this, and we need more, we need more people. We need more things. And there is all kinds of survival things out there, but that people face and don’t stop, just because some conversations about where the realities of the field are, are disheartening. If anything, that should be something that helps to fire you up even more.
Katie Vernoy 22:25
Sure, but it can be exhausting. I think when we’re looking at what folks can actually do, there are workplaces that are better than others. There probably should be a minimum standard that is put in place. There is not but there probably should be so that somebody can go in and recognize: my work will be appropriate, not 60 hours a week. My pay will be sufficient as a livable wage, and it won’t be ideal. There may be times when I’m seeing six clients a day, or seven or eight or nine clients a day, which is what I did when I was in DMH world at certain points. But for folks who can’t hang for whatever reason, they financially don’t have the stability to work for less than a certain amount, or they don’t have the capacity. I know for myself, I don’t have the same physical capacity that I did before, and maybe that’s part of the problem is that I burn myself out physically, but I have a lot of medical conditions that I just can’t do as many hours, right? And so some folks can’t sit in the in the chair, so to speak, for that many hours. And they can’t, they can’t have the status quo. They can’t do the work in the status quo. Some folks don’t have the the right word is, I’ll be kind and say motivation, to sit with it. And there are other options. And I think that’s the hard part, is folks can go out and be coaches. Folks can go to other fields. They can do other things. And that makes me concerned, because we’re losing mental health and medical professionals across the board due to the unsustainability of the professions. And so when we look at clients or patient care, it gets, you know, starker and starker to think about. I don’t know. I feel bad being such a gloomy gus today, but I, I worry that we’re asking folks who are already strapped for resources or spoons or whatever to to keep fighting.
Curt Widhalm 24:58
The alternatives are: the system continues to march along, and it continues to be what it is. It continues, as Ben says in his book, that grad school becoming more and more expensive, people rushing out to do private practice and therapy becomes by the rich and for the rich. And I will say through the years that people will reach out to me and say, hey, I want to be a therapist. What are your thoughts? And I share with them: Here’s what therapists make, here’s the cost investment, here’s the realities of getting through pre licensed hours working in agencies to eventually get to the place where you and I are, and maybe I’m just gloomy in those conversations too. But I will say, more often than not, people are having those conversations with me and choosing not to even go to grad school in the first place. And we look at even some of the people who are successful in grad school, who get a bead on this, and then decide, hey, that was a really good education, and I am going to go and choose a life that is sustainable for me and do the coach thing that you’re talking about. More power to them. Because I think that those stories also need to be brought up more and more, because when you and I are talking with elected officials or their staff and talking about the difficulties of having a sustainable workforce, these are the kinds of things that actually start to resonate. That are things that hey in a grad school class or cohort of 50 people, 10 probably aren’t going to get registered with their licensing board because they got their master’s degree and they’re moving on, and out of the remaining 40 life circumstances are going to make it to where another third of them aren’t going to end up getting licensed or practiced. So we’re not actually getting anything going on. I think this conversation is really stuff hasn’t changed, and the stuff that we are doing to advocate, and maybe this is space for a need for more innovation when it comes to advocacy around pay and looking at the systems that really, if we are talking about educating grad students, it’s looking at how the systems of pay and grants and contracts and all of that kind of stuff influences this. So that way some of this energy, at least in some of the public sector, ends up being something that can help address this. But I don’t think that we’re saying really anything new. We’re just kind of lamenting that, yeah, this is a problem, and it brings up problems from all directions, that there’s a delicate balance that just doesn’t seem to be changing.
Katie Vernoy 28:00
So, how do we get to a call to action or hope here? Because I feel like we’re just saying, yeah, things suck, and they haven’t changed. And I feel like some things have gotten better. I think that mental health stigma has gone down. So there is more of a need and more of a demand for services that theoretically, if we believe in capitalism, suggests that we can charge more or have more folks get paid to do the work. And big tech seems to think that we’ve got a field that’s worth mining. Think of a better word than just mining for mining for money. And so maybe there’s maybe there’s some innovation there. Maybe we don’t look at the things that are coming into the field as threats. Maybe we start looking even more deeply into how do we learn from other sectors to continue to try to improve the field? And I’ll link to the episode we did on I think we called it therapy reimagined, and talking about, you know, how we can learn from big tech and that kind of stuff. But I feel like the real thing is there is a path to a sustainable career. It just you might have to kind of slog through the mud first right now.
Curt Widhalm 29:19
We’d love to hear your thoughts. You can share them with us on our social media. Join our Facebook group, the Modern Therapist Group. You can reach out to us at podcast@therapyreimagined.com, you can find our show notes over at mtsgpodcast.com, and until next time, I’m Curt Widhalm with Katie Vernoy.
… 29:37
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Announcer 29:37
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